measures Normal near vision usually indicates that the patient has not sustained a significant ocular injury If a patient demonstrates poor acuity in the traumatized eye, the clinician should suspect that the deficit is injury-related However, one can readily establish whether this deficit is related to the trauma or uncorrected refractive error using the pinhole test When a person looks through a pinhole and experiences improvement in performance on visual acuity testing, he or she may have uncorrected refractive error as the cause of the initially tested poor vision If the visual deficit does not improve through a pinhole and therefore is likely related to the trauma, an ophthalmologist should be consulted The urgency of evaluation will depend on the mechanism of injury and other physical examination findings Inspect the Periorbital Tissues and Eyelids Thoroughly The periorbital tissues and eyelids should be carefully examined for ecchymosis, laceration, deformity, swelling, tenderness, and ptosis Palpation of the orbital bones should be performed to assess for tenderness, deformity, or step-off that may suggest orbital fracture If crepitus is present, it may be indicative of a fracture communicating with a sinus Laceration in the periorbital tissue should be assessed for fat prolapse, which suggests communication with the orbital compartment and need for ophthalmology consultation It should also be assessed for occult foreign bodies that may embed innocuously into the orbital compartment Examine sensation to evaluate for infraorbital or supraorbital nerve injury secondary to laceration, blunt trauma, or orbital fracture For eyelid lacerations, careful attention should be paid to the location of the laceration and the depth of the wound The eyelid should be everted to evaluate for subconjunctival and globe involvement, indicating that the laceration may be a full-thickness, complete perforation Lacerations in close proximity to the medial canthus should prompt ophthalmology consultation for evaluation of the integrity of the lacrimal duct system Open the Eyelids If the patient is unable to open the eyelids voluntarily, the examiner should assist the patient A warm compress may be applied gently to the eyelashes to loosen any crust, blood, or discharge that may be holding the eyelashes together When opening the eyelids, avoid pressure on the globe, which might lead to extrusion of intraocular contents via an underlying open-globe injury The examiner’s thumbs can be placed on the supraorbital and infraorbital ridges while exerting pressure against the underlying bone, and then pulled away from each other such that the